Geographic Inequities in Healthcare Access Across New York City
1 Introduction & Motivation
New York City, home to more than 8.4 million people from every corner of the globe, boasts one of the most advanced and extensive healthcare systems in the world. From world-renowned academic medical centers such as Mount Sinai, NYU Langone, and Columbia University Irving Medical Center to hundreds of community health centers and federally qualified health centers (FQHCs), the city offers an impressive array of services. Yet despite this abundance, equitable access to care remains a persistent challenge. Many residents—particularly those living in outer boroughs and historically under-resourced neighborhoods—face significant barriers to timely and affordable primary care.
Primary care is the foundation of a healthy population: it provides preventive services, early detection of illness, chronic disease management, and a first point of contact for most health concerns. When access is limited, small health problems can escalate into emergencies, preventable hospitalizations rise, and overall life expectancy and quality of life suffer. Aggregate citywide statistics, such as the total number of hospitals or physicians, often paint an overly optimistic picture. These figures mask dramatic neighborhood-level variation. For many New Yorkers, healthcare is experienced locally—shaped by walking distance, the reliability of public transit, availability of personal transportation, and financial constraints. A state-of-the-art hospital on the other side of the city might as well not exist for someone who cannot easily reach it.
This project takes a more granular approach by examining access at the census-tract level—the smallest geographic unit for which detailed demographic data are available. By zooming in to this scale, we can uncover intra-borough variations and reveal how multiple barriers intersect. We explore the interplay between physical proximity to healthcare facilities and socioeconomic factors such as income, insurance coverage, poverty rates, racial/ethnic composition, and the proportion of foreign-born residents. Recent studies and policy reports continue to highlight persistent gaps in outer-borough primary care, mental health services, and specialized care. Initiatives such as the expansion of school-based health clinics in the Bronx and central Brooklyn, or the city’s efforts to increase FQHC capacity, reflect ongoing recognition of these challenges.
Understanding these patterns has clear policy relevance. Accurate measurement of where and how access is lacking can guide targeted interventions: new facility openings, mobile health units, improved transit connections, expanded insurance enrollment programs, and culturally tailored outreach. True health equity requires not just more resources, but resources allocated where they are needed most.
2 The Big Question & Why It Matters
Overarching Question (OQ):
How does geographic access to healthcare facilities vary across New York City at the census-tract level, and what socioeconomic disparities exist in healthcare access?
Geographic proximity is only one piece of the puzzle. Even when a clinic is nearby, economic barriers, lack of insurance, language challenges, and limited mobility can prevent people from receiving care. Higher-income residents can more easily overcome distance through taxis, rideshares, or private vehicles, while lower-income individuals may be constrained by public transit schedules or the cost of travel. Thus, access is a multidimensional phenomenon.
To address the overarching question, we break it down into five interconnected dimensions, each led by a team member:
- Geographic Distribution (Matthew): Which census tracts are true “healthcare deserts” (less than half the land area within a 10-minute walk of any facility)?
- Borough & Neighborhood Supply (Imani): How many facilities actually exist per person in each borough and ZIP code?
- Income & Affordability (Jason): How does household income affect the ability to obtain timely care, even when a facility is nearby?
- Socioeconomic & Racial Patterns (Zhuohan & Saoni): How strongly do poverty, race/ethnicity, and foreign-born status predict living in a low-access tract or being uninsured?
- Insurance as a Second Barrier (Yashvi): How does lack of health insurance compound the problem of physical distance?
By integrating these perspectives, we move beyond simplistic proximity metrics to a richer, more realistic understanding of how and why unequal access persists—and which factors exert the strongest influence.
3 Data & Approach (Non-Technical)
The analysis draws on two main sources:
NYC Facilities Database (maintained by the Department of Health and Mental Hygiene and the NYC Open Data portal): This provides the locations of hospitals, diagnostic and treatment centers, community health centers, FQHCs, and other sites capable of delivering primary care.
American Community Survey (ACS) 5-year estimates (2018–2022): Tract-level data on population, median household income, poverty rate, uninsurance rate, racial/ethnic composition, and percentage of foreign-born residents.
To measure geographic access, we created 10-minute walking catchments (approximately 0.5 miles) around each facility using street-network walking time rather than straight-line distance. These catchments were overlaid onto census tracts to calculate the percentage of each tract’s land area covered. Tracts with less than 50% coverage were classified as healthcare deserts. Population-adjusted metrics (facilities per 10,000 residents) were computed at borough, ZIP code, and tract levels. We then used correlation analysis, linear regression, and scatterplots to explore relationships between geographic access and socioeconomic variables. Maps, bar charts, and density plots help visualize spatial patterns and overlapping vulnerabilities. The tract-level resolution reveals disparities that borough averages conceal.
4 Key Findings (Integrated)
Healthcare access in NYC remains markedly uneven, driven by geography, supply-demand mismatches, affordability, and indirect demographic influences.
About 9% of census tracts qualify as healthcare deserts, with under 50% of land area within a 10-minute walk of primary care facilities, impacting over 500,000 residents. These cluster predominantly in the Bronx, eastern Brooklyn, and parts of Queens, while Manhattan enjoys extensive coverage (Figure 1). Recent reports affirm outer-borough under-provision in primary care and specialized services.
Deserts concentrated in outer boroughs, aligning with ongoing disparities.
Population-adjusted metrics sharpen disparities: Manhattan boasts the highest facilities per capita, whereas Queens and Staten Island rank lowest, highlighting inadequate scaling in growing areas (Figure 2). Brooklyn leads in raw counts but lags per resident in certain neighborhoods.
Population adjustment exposes outer-borough shortfalls.
Affordability emerges as a pivotal barrier. Lower-income tracts exhibit elevated uninsurance rates, hindering utilization despite proximity (Figure 3). Enrollment assistance centers are disproportionately scarce in Queens, the Bronx, and Staten Island, perpetuating cycles of limited access (Figure 4).
Affordability drives practical access.
Fewer centers in undeserved boroughs.
Foreign-born residents, comprising a substantial city portion, show no robust linear correlation with provider density (per 10,000 residents). Scatterplots and regressions indicate near-zero overall relationship, though select immigrant-dense tracts overlap with low-supply areas (Figure 5). Barriers like language and cost disproportionately affect immigrants, yet proximity patterns are not directly predictive.
Providers per 10,000 vs. % Foreign-Born: Minimal relationship.
Walking proximity displays weak ties to income (minor negative association, small magnitude, p<0.001) and none to minority share (p=0.778). Low explanatory power suggests dominance of non-demographic factors like urban density and transit (Figures 6 & 7).
